Institutional and Policy Environments for Promoting Nutrition

Institutional and Policy Environments for
Promoting Nutrition in Bangladesh
Presented by:
Aktari Mamtaz
Joint Secretary
Ministry of Health and Family Welfare
People’s Republic of Bangladesh
Bangladesh: Country Profile
 Country Area
: 1.47.570 sq. km.
 Total Population
: 151.41 Million (BBS 2010)
 Population Density (per sq. km.)
: 993 persons (BBS 2009)
 Life Expectancy at Birth
 Maternal Mortality Rate
 Infant Mortality Rate
--
Male
: 65.7 years (BBS 2009)
--
Female
: 68.3 years (BBS 2009)
( per 1000 live births)
( per 1000 live births)
: 1.94 (BMMS 2010)
: 52 (BDHS 2007) (<1 Yr)
 Neonatal Mortality Rate (<1 Month)
: 37 percent (BDHS 2007)
 Child Mortality Rate (<5) (per 1000 live births)
: 65 (BDHS 2007)
• Per Capita Income
: US$ 818
2
Achievements made so far
 Bangladesh has made considerable progress in
high rates of
economic growth and reducing poverty rates by 8 per cent
between 2005 and 2010.
 In 2010, Bangladesh received the Millennium Development Goal
(MDG) award for remarkable achievement in reducing child
mortality (MDG 4).
 Bangladesh is also currently on track to meet MDG 5 (Maternal
Health)
 Bangladesh received Digital Health for Digital Development award
in 66th UN General Assembly for contributing Maternal and
Children Health through ICT.
Common Nutrition Problems in Bangladesh
 Protein-energy malnutrition(PEM)
 Maternal Malnutrition(MM)
 Iron Deficiency Anemia (IDA)
 Vitamin A Deficiency(VAD)
 Iodine Deficiency Disorder(IDD)
 Low Birth Weight (LBW)
 Zinc Deficiency
 Over nutrition(emerging )
Share of Energy Intake in Rural Bangladesh
Howarth Bouis, 2006
Staples
Non-staple
plants
Fish and
animal
Food Insecurity in Urban Slums
Household
Dhaka
consumption
Chittagon
g
Khuln
a
Rajshah All
i
Absolute food
insecurity:
<2,122
kcal/person/d
42.4
56.0
52.0
61.3
47.8
Extreme food
insecurity:
<1,805
kcal/person/d
24.2
35.8
38.5
36.0
29.0
Urban food security Atlas, 2008
Present status of Nutrition in Bangladesh
 Chronic and acute malnutrition levels are higher
than WHO thresholds
 Children under weight for age is decreased from
47.5% in 2004 to 37.4% in 2009
 Children under weight for height(wasting) increased
from 14% in 2004 to 17% in 2007
 Children short for age(stunting) increased from 43%
in 2007 to 48.6% in 2009
Present status of Nutrition in Bangladesh(cont.)
 Iron Deficiency Anemia among women and pre-
school children is 51% and 68% respectively
 Vitamin A supplementation has consistently
increased from 82% in 2004 to 88% in 2007
 Night blindness among children of age 18-59
months is 0.04% in 2005, well below the WHO
thresholds
 Prevalence of night blindness among pregnant
women and lactating mother is 2.7% and 2.4%
respectively.
Based on evidence formulated policies and plans
 1983 - National Nutrition Policy
 1997 – National Food and Nutrition Policy
 1997 – National Plan of Action for Nutrition
 2006 – National Food Policy
 2008 – National Food Policy Plan of Action
 2009 - National Health Policy
 2010 - National Agriculture Policy
 2011 – Country Investment Plan
 2011 - National Food Safety Policy and Action Plan (in progress)
Interventions taken and Implemented
 Bangladesh Integrated Nutrition Project (MOHFW)
 National Nutrition Project (MOHFW)
 Micronutrient supplementation Initiatives(MOHFW)
 Fortification of edible oil and salt iodization (Industry supported by





MOHFW)
Rice ,cereal, vegetable production and diversification of Crops, (MOA )
One House One Farm Project (LGRD)
Fish and Poultry Programs for fulfill protein gaps (MOFL)
Regular Awareness Program through Media(Information)
Developed food policy and Country Investment Plan targeting
sustainable food security and Nutrtion (Food and Disaster Management)
Evidence of Implemented interventions
1.
2.
3.
4.
5.
Scaled up comprehensive nutrition intervention through NNP
in different parts of Bangladesh( around 30-40% coverage).
Stunting rate has decreased remarkably from 71% in 1992 to 45%
in 2007.
Underweight rates showed substantial decline from 61% in
1992 to 42 % in 2007.
Proportion of women with low BMI reduced from to, from 53%
in 1996/97 to 30 % in 2007.
Linking de-worming campaigns with vitamin A
supplementation intervention
Rice production
 Rice production tripled since Independence
Bangladesh is close to self-sufficiency in normal years
35000
Average growth rate between 2000 and 2010: 3%
30000
Thousand MT
25000
20000
15000
10000
5000
0
Total rice
Source: BBS except own estimates for Boro 2010
Aus
Aman
Boro
Current GOB Programs and Initiatives to
address Under Nutrition
 Country Investment Plan(2011-2016),MOFDM
 One Farm One House(2011-2016)(6000 farm will be
establish), MOLGRD
 Fortification of Edible oil and Salt Iodization(2011-2016),
MOI
 Rice , cereal, vegetable production and diversification of
Crops(2011-2016),MOA
 Health , Population and Nutrition Sector
Development Program (2011-2016),MOHFW
Country Investment Plan, MOFDM(12 programmes)
COMPONENT
PROGRAMME
Sustainable and diversified agriculture through integrated research and extension
Improved Water Management and infrastructure for irrigation purposes
Food Availability
Improved quality of input and soil fertility
Fisheries & Aquaculture Development
Livestock Development, with a focus on poultry and dairy production
Improved access to markets, value-addition in agriculture and to non farm incomes
Strengthened capacities for implementation and monitoring of NFP and CIP actions
Food Access
Enhanced Public Food Management Systems
Institutional Development and Capacity Development for more effective safety nets
Community based nutrition programs and services
Food Utilization
Orient food and nutrition programs through data
Food safety and quality improvement
Health , Population and Nutrition Sector
Development Program, MOHFW
 National Nutrition Services(NNS) MOHFW
 Maternal, Neo-natal and Child Health Care
 Community Based Health Care
 Maternal, Reproductive and adolescence Health
 Micronutrient supplementation by Institute of Public
Health Nutrition (IPHN)under MOHFW
Targeted Nutrition Indicators for Current 5
Year’s Plan(2011-2016)
1.
2.
3.
4.
5.
To reduce the prevalence of Low Birth Weight (<2,500 g)
from 36 % to 20% or less…..
To reduce the prevalence of underweight (WAZ <-2 Z-scores)
in children <5 years from 48% to 36%....
To reduce the prevalence of stunting (HAZ <-2 Z-scores) in
children <5 years from 43% to 37%
To reduce wasting (WHZ < -2Z) in <5 years from 13 % to 8 %
To maintain the prevalence of night blindness among
children aged 12-59 months below 0.5%...
Targeted Nutrition Indicators for Current
5 Year Plan(2011-2016)(Cont.)
6. To Reduce night blindness among pregnant women below .5
%
7. To reduce the prevalence of anaemia in < 5 years children
from 49% to 40%, adolescents from 30% to 20%, and in
pregnant women from 46% to 30%.
8. To reduce the prevalence of iodine deficiency (UIE <100
g/L) from 43% to 23% of all school aged (6-12years)
Children
9. Pregnancy wt gain more than 9 kg or more in 50 % of
pregnant women
10. To increase household food consumption (egg, meat, fruits)
through homestead food production.
Implementation Progress of Current
Interventions of MOHFW
 Policy Achievement:
 To Scale Up Nutrition, MOHFW has decided to shift from
vertical program (NNP,1994-2011, implemented in 172 sub district,
which ended on June 2011) to an integrated nutrition service
named the National Nutrition Service(NNS)
 Line Director NNS will provide necessary supervision ,
guidance and coordination between related Operation Plans
to ensure Scaling Up Nutrition.
 All facilities under DGHS and DGFP providing Maternal and
Neonatal Health services will be made available for integrated
nutrition service delivery
Implementation Progress(cont.)
 Components NNS
 Includes the interventions for the first 1000 days
 Evidence-based direct interventions to prevent and treat




under nutrition
Treatment of severe acute malnutrition
BCC to promote good nutritional practices
Coordination of nutrition activities across different sectors
and strengthen sectoral collaboration
Mainstreaming gender into nutrition programming
Implementation Progress (cont.)
 Targeted Modalities:
 Accelerate the progress in reducing high rates of under
nutrition by mainstreaming the implementation of Evidence based direct interventions into regular Health and Family
Planning Services
 Scaling up community-based nutrition services through
Community Clinics
 Updating the National plan of Action
 Capacities of District hospitals and Upazila Health Complexes
will be strengthened to adequately manage severely
malnourished cases
Special attention should be paid to
 Operationalizing the NNS to ensure coordination in
nutrition interventions
 Human resources development in terms of capacity
building of existing workforce in the health sector
 Ensuring multi-sectoral coordination and establishing
intra and inter-ministerial linkages on nutrition
interventions and
 Conducting a stock taking and a costing exercise as
soon as possible.

Opportunities …..
 State’s political commitment.
 National Plan of Action on Nutrition,1995(will be under





current sector program)
National Infant and Young Child Feeding (IYCF) strategy
and action plan.
National communication strategy on IYCF and action
plan.
National food Policy and Action Plan
Country Investment Plan(CIP),2011( a road map towards
investment in agriculture, food security and nutrition
Other Ministries Involvement
Opportunities….
 Research Started for improved yield of cereals, for
improving the quality of soil
 Also for increased yield of pulses, vegetables, poultry
and livestock
 Food fortification has just started in the country; wheat
flour and perhaps rice should be fortified with
micronutrients
Challenges .....
1. Knowledge and awareness among the policy makers,
health workers, concerned parents and mass people
regarding:
• Under nutrition and it’s future impact
• Efficient way out from under nutrition
2. Lack of priority focus on critical age (9 months pregnancy
to 24 months) in the national program
3. Lack of focus on future mothers (adolescence girls)
Challenges ....
4. Lack of capacity of existing frontline nutrition service
providers
5. Lack of optimum monitoring mechanism in nutrition
program implementation
6. Lack of community mobilization regarding the impact of
under nutrition
7. Inadequate human resources
8. Lack of Nutrition Sensitive Agriculture
9. Decreasing Agricultural Lands due to rapid urbanization by
housing companies
Key recommendations to face the
immediate Challenges
 The need to produce enough food that could satisfy





hunger
Equally important – to produce food that could
control under nutrition
Produced food has to be nutritious, providing macro
and micronutrients
Food has to be available and accessible
Nutrition Sensitive Agricultural Production
Eliminate gaps of Coordination and Collaboration in
relevant sector
Support needed to Address Under Nutrition
 Financial
 Technical
 Capacity building
 Information and knowledge Sharing
 Bio-medical research related to nutrition
Support is most essential for Capacity Building
To develop efficient HR for field level of relevant sector.
2. To develop excellent Nutrition Core Management Group in
country level, who will own the Scaling Up Nutrition
(SUN) movement and will able to bring the targeted result
3. To establish a common data base for SUN initiatives
through which progress of all interventions could be
tracked online
4. To develop efficient IT people for nutrition data
management
1.
Development partners could support the
process of scaling up Nutrition
 To stimulate State authorities regarding nutrition & food
security sensitive development approach.
 To increase the coverage of tested nutrition interventions
according to Lancet series on maternal and child under
nutrition
 Could mobilize political commitment for Scaling Up
Nutrition(SUN).
 Provide necessary Resource to support Nutrition
Interventions
Thank you all